We waited around all days yesterday to hear from the hematologist, only to find out that we might get the results on Friday. He did stop by today to explain a bit more about his thought process with the tests, though. He explained that there are 3 criteria for remission: 1) peripheral blood counts come back normal with no cancer cells (we already have that) 2) Bone marrow biopsy shows less than 5% blasts (immature cells), and we all have blasts 3) Molecular studies with the PCR test (which he sent out) comes back negative indicating a complete molecular remission. He thought that this test would come back sooner than it has, with the thought that if it came back negative, we can save Eric the discomfort of going through a biopsy. If it is negative, then we can stop giving him ATRA, and we are almost certain that he is in a remission. We'll then wait for him to get better to discuss maintenance therapy. If it comes back positive, he'll then schedule a bone marrow biopsy and continue to give ATRA. If the biopsy come back negative, then we wait for him to get stronger and discuss the issue of the risk of relapse. If the biopsy comes back positive, then we have a very difficult discussion on what to do, since he can't handle more chemo in his current state. He did say that the chances of the PCR test coming back positive at this stage of therapy for anybody is fairly high, but they don't normally request this test at this stage... meaning there isn't much data. Also, Eric had a very high white blood cell count initially, which statistically reduces his chance of remission. It's not really good news, but at least we understand more.
He seemed to have a good night. They had to go up on his oxygen settings again to 60%. I think he's been coughing a lot during the night and this morning and getting a lot of mucus out. I haven't seen the critical care docs yet, but I think this is good. He needs to get everything that has built up the past month out of his lungs to breath easier. The kidney docs decided yesterday to try him off of dialysis. His kidneys appeared to be functioning better, but they can only really tell when he is off of dialysis. So, they took him off around 4 pm yesterday, and 18 hrs later, his vitals still look good! His BUN increased as of 2 am this morning, but his creatinine (which is what they use to determine kidney function) is still in a good range. I'm anxious to hear what the kidney docs have to say this morning.
He's still scheduled for a tracheotomy tomorrow morning at 7:30, but the doctor is concerned about the air under his skin. He was saying that this could pose a risk of infection during the procedure, but he really needs to get the ventilator tubes out. He said he'd reassess him tomorrow morning, to make the final decision.
Pray hard for the PCR test to come back negative!!! He's looking so much better, and it would be so hard to hear that his leukemia might still be there.
Love,
Melissa
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Hang in there you guys. We're thinking of you and Eric all of the time! Praying that everything goes well with the tracheotomy and these rounds of tests.
ReplyDelete-Love, Sarah Soboleski
That's such great news about his vitals and that he was coughing! That means he's still fighting, getting stronger, and ready to get off that thing!!
ReplyDeleteTwo questions... Don't understand criteria #2)he need less than 5% blasts but he currently has all blasts?? or am I misunderstanding that? If the PCR isn't negative, that means they will verify the results with a biopsy before any decisions need to be made?
Tomorrow is a big day, but he sounds ready to take it on!! Really excited for you guys!
He needs less than 5% of blasts in his bone marrow. We all have blasts, since they are just immature cells, but if he has more than that, it's a sign that the leukemia is still there. We don't know if he has any blasts right now, since none are showing up in the blood.
ReplyDeleteThey will verify the results with a bone marrow biopsy before making any decisions. It is possible that the PCR is positive and the bone marrow negative. That just means that there is a chance of relapse, but that it has not happened (yet?). In that case, they would normally like to do another round of less-intensive chemo, but they have to wait till he gets stronger.
Melissa
Ok! Totall misread #2! LOL! I thought "how can he have all blasts?" Should have had more coffee before I read the update! So they can't detect any right now... Good sign.
ReplyDeleteAnd as a funny side, all I remember from PCR is that when it gave me results they never seemed right!! LOL!
Sounds like it's all trending towards the positive (outcome that is, not PCR results)! Such a good sign!